Provider Demographics
NPI:1710172689
Name:SPENCER, NATHANIEL JAMES (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JAMES
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 31ST ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3973
Mailing Address - Country:US
Mailing Address - Phone:626-590-6502
Mailing Address - Fax:
Practice Address - Street 1:965 48TH ST
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2919
Practice Address - Country:US
Practice Address - Phone:718-283-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112545207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine